Provider Demographics
NPI:1114901204
Name:SAMANT, PRIYA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:
Last Name:SAMANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-3913
Mailing Address - Country:US
Mailing Address - Phone:405-272-0476
Mailing Address - Fax:405-272-0730
Practice Address - Street 1:411 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-3913
Practice Address - Country:US
Practice Address - Phone:405-272-0476
Practice Address - Fax:405-272-0730
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18731207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK18731OtherMEDICAL LICENSE
OK100231030AMedicaid
OK14296OtherBNDD
OK14296OtherBNDD
OK100231030AMedicaid
OKBS3927906OtherDEA